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Monitoring in Type 2 DM
Albuminuria describes a condition in which urine contains an
abnormal (high) amount of albumin. In people with Type 2
Diabetes (DM), albumin is the primary protein excreted by the
kidneys. Albuminuria is usually a marker of nephropathy and
CVD. High levels and/or a rapid rise in urine albumin may be a
sign of serious kidney disease. Not all kidney disease in people
with diabetes is diabetic nephropathy; consider other causes of
kidney damage.
The gold standard for kidney testing in people
with diabetes = UACR and eGFR
5. UA dipstick
Only detects higher levels of proteinuria (>300mg/g)
Not precise and cannot be used to assess or monitor albuminuria in
Type 2 Diabetes
Management of Albuminuria
The following strategies should be implemented to reduce
albuminuria, prevent/slow nephropathy progression, and lower
the risk of CVD:
Maximize ACE Inhibitor/ARB
BP Control
Stop smoking
Lipid Control
Protein restriction (later stages) Glucose Control
Repeat UACR to monitor effectiveness of intervention; a
decrease in urine albumin is therapeutically significant.
Developed by the IHS Division of Diabetes Treatment and Prevention - November 2009.
The Diabetes Care and Outcomes Audit will count any type
of urine protein screening, but UACR is preferred
Albuminuria is a continuous variable, the terms microalbuminuria
and macroalbuminuria are going out of use.
Since these terms are still used for ICD9 Coding:
Normal
= < 30mg/g
Microalbuminuria = 30 - 300mg/g
Macroalbuminura = > 300mg/g